Last night was a successful attempt to match how much I ate of what things, my general wellbeing, and my insulin. I had a big dinner that I counteracted with insulin, but then I watched to see how quickly my levels climbed back up after the three (3) hour window of effectiveness ended. Then, based on the rate my level rose, I gauged how much additional bolus insulin and how much basal insulin I should inject. Happily I hit it right. My levels stayed constant overnight, and within target range.
This is an interesting example of how eating light and staying active allowed me to avoid insulin on Friday. When I woke in the morning, I was within an acceptable range. I ate for the first time at 11:30 am, and indeed my levels began to climb. Rather than going for the insulin, I went for the treadmill and continued my computing while walking at my treadmill desk. This brought my levels back down, and they continued to drop for the rest of the afternoon until dinner.
I like the idea of adopting a vegetarian (vegan if possible) diet, but I am still struggling to see how I would do that without relying on lots of insulin. So many vegan dishes are heavy in carbs. Wednesday the 20th was a day to explore how I’m doing in general related to a vegan diet. I attended an event that served a vegan dinner. Prior to arriving, I snacked on nuts and cheese to make sure that I would not be too hungry. That didn’t lift my blood sugar materially. Then, as dinner was served, I bolused 6 units, which is how much I currently use if I’m expecting a carbo load in what I’m intending to eat. This brought my levels back down into the 120’s briefly, but as the bolus (fast-acting) insulin began to wear off, my levels climbed back up into the 170’s-180’s around the time I planned to go to sleep. I decided to inject another bit (2 units) of bolus (fast-acting) insulin to bring the levels down, and then went with four (4) units of basal insulin to carry my through the night. I didn’t want to inject too much insulin right before bed because then I might crash as I slept, which is always risky business.
The four (4) units were not enough to keep my levels even overnight. I crept back up, waking up around 170’s. If I had it to do over again, I would have used five (5) units of basal (long-acting) insulin.
I found interesting to be reminded that sleep is the state where sugars rise. Without eating anything, I finished the morning routine and then rode my bike to school with my son. By the time I finished the morning thrash and I returned from a short ride (5-10 minutes each way), my numbers had dropped back down into the 120’s.
The takeaway here is that how much carb load lingers in one’s system impacts how quickly the system can recover to healthy levels of blood sugar. By 9 am, I didn’t have much source of blood sugar remaining in my digestive track, so mild activity was sufficient to bring my levels back down.
I had a weird day when both my CGM was acting a little squirrely and my blood sugar response to exercise was different than normal. I had a low carb dinner, but then some desserts came out. I decided to see how well I could handle them given that my levels had been so consistent for several days running. At first I couldn’t believe how steady and low they remained (150’s) despite some sugary goodness. Then I started getting suspicious. I decided to calibrate and discovered that I was reading at least 30 points too low. Now I was in “high glucose” alert range. When I exercised for 30 minutes later that evening which would normally bring me right down, I was surprised to watch my levels not drop as much as normal. They stayed stuck around 120’s even though I’d been at it pretty hard for a full 30 minutes.
When I checked in the morning, my levels were higher than I like for an overnight read. The CGM said 150’s! Drat. “I should have used some basal insulin last night!” I thought to myself. But then I decided to check, and discovered that the CGM was again off, but this time in the opposite direction. It was reading 30 units too high, rather than 30 units too low. When I adjusted back to correct that number, I was in the 120’s overnight. That was fine, as far as I am concerned.
Suffice it to say that there was something odd going on.
I stand by my belief that adhering to a low carb diet makes it easier for the body to keep things in balance. Piling on a bunch of sugar, even though you have insulin to help you out, will make it hard for the body to adjust and level out at a good spot.
Later that day, I appeared to have cleared out whatever gunk was clogging my endocrine system. After a breakfast of nuts, seeds and yogurt that would typically have required 5 units to keep balanced, I tried bolusing 4 units only to have my levels drop farther than I expected. Some more food and a little more exercise afterward balanced it all out.
After fasting for most of the day, I had a light snack of mixed nuts mid afternoon and then a light dinner of a spinach Indian dish called Palak Paneer. With 5 units of Humalog, my levels dropped lower than their standard 120. Perhaps it was too much insulin? But after it wore off, the numbers climbed back up into the 120’s and stayed steady throughout the night until breakfast the next day.
I decided to keep the low-insulin experiment going. Though my numbers had climbed after breakfast, I decided to see if I could walk off the blood sugar. It turns out that I could with an hour’s walk on the treadmill as I did computer work.
My BG levels stayed level throughout the night. When I got up and hit the hour where I might have normally eaten breakfast, my levels rose slightly more. This was probably a stress response. I keep up my fast until four pm. Overall, my day was steady. This was interesting because I’d thought I needed to eat regularly. I’ll experiment with fasting more to see how I respond under different scenarios.
An acquaintance mentioned that some health fad has advocated for fasting. I hadn’t given it much thought, but this experiment leads me to believe that I could look into it. 
On March 17th, I relied on a combination of insulin and exercise. My lunch had been light on carbs, so I bolused only 4 units. Then I nibbled a bit more as I prepared dinner and then ate it. It seemed all was fine according to my CGM, but I’d eaten a fair amount and my eyes were feeling twitchy in the way they do when my BG levels are too high. I decided to calibrate and confirm that the CGM was correct. In fact, it reported my levels about 40 points too low. I was actually above my “high glucose” threshold. That prompted me to do elliptical for 35 minutes to bring it back down to around 70 or so. I figured it would rise again as I slept, but I was happy to see that my levels remained level, and even dropped overnight.
I went to bed a tinge hungry. Because there was no additional food to digest, it seemed my basal insulin was sufficient to keep my level constant throughout the night.
It is a truism that some foods have more carbs than others. The more carbs you eat, the higher your blood glucose can climb. If you’re using insulin, you’ll need more to counteract a heavy dose of carbs.
So the counterpoint can also be valid. Low carb foods can lower the amount of insulin you need.
I’ve adjusted my diet since becoming diabetic to do this. It is much easier to manage my levels when I don’t have huge carbohydrate loads to contend with. I can usually fill up on low carb vegetables (which is healthy in its own regard) and rely on fewer foods that are heavy with carbs.
But even if I eat only a seemingly no-carb option, if I eat a lot of it, my sugars will still climb. There is something about being FULL that stresses my system and causes me to struggle to keep my levels low.
Last night, I had dinner early. It had probably been at least six hours before I went to sleep. I was at 113 when I went to bed, and I was a tad peckish. Rather than eating something, I drank some water to fill the “empty spots” in my stomach. I was curious to see how much my levels would climb over night without any long-acting (basal) insulin.
This morning I was at 132. I found that encouraging. It wasn’t a flat line, but it remained within range. Had I gone to bed earlier or had I been better about exercising these last couple days, it might have stayed completely level. That suggests that I’m still producing some insulin, since my nutritionist says the levels would rise rapidly overnight without insulin for someone who has no exogenous insulin production.
The real take-away for me is validity of the old Japanese adage, “Keep your stomach at 8/10th full.” (Hara, hachi-bun me.) Eating too much taxes the system. When I can monitor my blood glucose as I can, I can see the negative, real-time impact of that extra and perhaps unnecessary second or third helping. Eating light is better for controlling blood sugar levels, even if eating no-carb foods.
No sooner do I post yesterday that insulin and exercise are hard to balance, then I get caught today in that very trap.
I bolused a regular amount for breakfast (5 units of Humalog against yogurt with nuts and seeds, plus two apple cores left over from the kids’ lunches), but had carpet cleaners come over. They moved up their appointment by several hours due to a cancelation, so I needed to immediately start moving the junk on the floor out of several rooms where they would be cleaning the carpet.
I didn’t imagine that it would be a big job, but it was a good hour of shuttling boxes and small furniture in and out of rooms. By the time I was just about done prepping, that frantic feeling of an impending crash was just beginning. Sure enough, the running around had amplified the impact of the insulin, and now I was going too low.
A couple oranges and several tablespoons of peanut butter later, I’m feeling fine, resigned to the fact that I’m likely going to spike here in the next hour. Ah…them’s the breaks. Maybe I can add lunch and an adjusting bolus of fast acting insulin to get me back into range.